"I'm Sorry to Tell You..." Physicians' Reports of Breaking Bad News

Department of Psychology, Bucknell University, Lewisburg, Pennsylvania 17837, USA.
Journal of Behavioral Medicine (Impact Factor: 3.1). 05/2001; 24(2):205-17. DOI: 10.1023/A:1010766732373
Source: PubMed


In this investigation the authors assessed what physicians do when planning for and delivering bad news to patients. Seventy-three physicians responded to a series of statements about the behaviors, thoughts, and feelings they might have had while preparing for and delivering bad medically-related news. Data were also obtained about how well they thought the transaction had gone, how much stress they had experienced, and what they thought the experience was like from the patient's perspective. Physicians reported that these transactions were only moderately stressful, with 18.1% and 18.7% indicating that preparation stress or delivery stress, respectively, were above the midpoint on the scale. Slightly over 42% of the sample indicated that the stress they experienced lasted from several hours to three or more days. Thirty-six delivery-related statements were typical (with endorsement rates of at least 80% in a given direction) for at least one of the two recall groups.

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    • "Not surprisingly, doctor's self-reports indicate that they find BBN stressful [11] [12], particularly when they feel a sense of responsibility for the news, [13] or fear the patient/family emotional reactions to the news [14]. Doctors also report that they sometimes have difficulty separating their own emotions from the clinical situation [15] [16]. "
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    ABSTRACT: The purpose of this study was to investigate the relationship between doctors' bad news delivery style and their experience of physiological stress during simulated bad news consultations. 31 doctors participated in two simulated breaking bad news (BBN) consultations. Delivery style was categorized as either blunt, forecasting or stalling (i.e. avoidant), based on the time to deliver the bad news and qualitative analysis of the interaction content and doctor's language style. Doctors' heart rate (HR) and skin conductance (SC) were recorded in consecutive 30s epochs. Doctors experienced a significant decrease in HR (F(1,36)=44.9, p<.0001) and SC (F(1,48)=5.6, p<.001) between the pre- and post-news delivery phases of the consultation. Between-group comparisons for the three delivery styles did not identify any significant differences in HR (F(2,36)=2.2, p>.05) or SC (F(2,48)=.66, p>.05). Doctors experience heightened stress in the pre-news delivery phase of breaking bad news interactions. Delaying the delivery of bad news exposes doctors to a longer period of increased stress.This suggests that medical students and doctors should be taught to deliver bad news without delay, to help mitigate their response to this stressful encounter. Copyright © 2015. Published by Elsevier Ireland Ltd.
    Patient Education and Counseling 08/2015; 98(10). DOI:10.1016/j.pec.2015.08.023 · 2.20 Impact Factor
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    • "Studies evaluating the psychological effects of prenatal diagnosis have described in detail the effect of receiving a diagnosis during pregnancy or after the birth [4], and the types of emotions experienced by women [7] [8] as well as by both parents [9] [10]. They have examined the ways in which the diagnosis is given by medical staff [11] [12] and in turn received by the parents [13] [14]. Further, they have evaluated the possible coping strategies [2] and the consequences over time of a pregnancy termination after the diagnosis [15]. "
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    ABSTRACT: The study's aim was to evaluate how information related to a prenatal diagnosis of fetal malformation could modify parenthood experience descriptions during pregnancy and after the child's birth. A longitudinal case-control clinical study was conducted. Data on parenthood experience descriptions collected using a validated semantic differential technique during pregnancy and after the child's birth were compared between seven couples of parents receiving a prenatal diagnosis of fetal malformation and seven couples without any fetal diagnosis. Our results show that during pregnancy parents in the clinical group describe themselves as more fragile, passive, and timid [p=0.007] than those in the control group. On the other hand, after the child's birth, there are no significant differences between groups. Data are discussed with reference to better knowledge of the psychological dynamics involved in becoming a parent and to rational planning of support for parents receiving a diagnosis of fetal malformation.
    Journal of Pediatric Surgery 02/2014; 49(2):353-8. DOI:10.1016/j.jpedsurg.2013.07.025 · 1.39 Impact Factor
    • "This may make it difficult for the counselor to be " in the moment, " as stressful feelings may interfere. The majority of research in communicating difficult news has been in the area of oncology, followed by obstetrics, pediatrics, trauma, and general medical practice (Baile et al., 2000; Bowyer et al., 2010; Cleary, Hunt, & Horsfall, 2009; Faulkner, 1998; Ptacek et al., 2001; Saviani-Zeoti & Petean, 2007). Certain key elements have emerged as central to this process and are similar across a variety of professions (Watson, 2008). "
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    ABSTRACT: Breaking bad news is a stressful experience for counselors and clients. In this article, the PEWTER (Prepare, Evaluate, Warning, Telling, Emotional Response, Regrouping) model (Nardi & Keefe-Cooperman, 200620. Nardi , T. J. and Keefe-Cooperman , K. 2006. Communicating bad news: A model for emergency mental health helpers. International Journal of Emergency Mental Health, 8: 203–207. [PubMed]View all references)is used as a guide to facilitate the process of a difficult conversation and promote client growth in a school setting. In this structured creative model, communication skills are grouped in a systemic and progressive manner that can be individualized to meet client and situational needs. PEWTER addresses the multiple factors and layers that affect the counseling situation when giving life-changing news. A case example is provided that outlines each phase of the PEWTER model.
    Journal of Creativity in Mental Health 07/2013; 8(3):265-277. DOI:10.1080/15401383.2013.821926
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